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Glossary

Bridge plating uses the plate as an extramedullary splint. It must be fixed securely to the two main fragments. The intermediate fracture zone is left untouched. Anatomical reduction of the intermediate fragments is not necessary but alignment, rotation and length of the bone must be restored.

Direct manipulation of the intermediate fracture fragments risks disturbing their blood supply. If the soft-tissue attachments are preserved, and the fragments are relatively well aligned and stable, healing is predictable.

Alignment of the main fragments can usually be achieved indirectly utilizing traction and soft tissue tension.

Bridge plates in the proximal ulna can be inserted through an open exposure with minimal soft-tissue damage. In open bridge plating, it is important to preserve soft-tissue attachments to the fracture fragments.

A bridge plate may be applied to medial, lateral, or posterior surfaces of the proximal ulna. The choice depends on other injuries, soft-tissue condition and surgeon’s preference. Positioning the plate posteriorly facilitates the sagittal reduction although is slightly more prominent.

Bridge plating can be done with a minimally invasive approach, which requires fluoroscopic monitoring. In minimally invasive surgery, a bridge plate is applied through one proximal and one distal incision, just wide enough for the plate. Control of reduction may be more difficult than with an atraumatic open technique.

Note: In healthy bone, it is not necessary to fill all screw holes proximal and distal to the fracture zone. However, in osteoporotic bone it is safer to use all plate holes outside the fracture zone, or to use an LCP. Multiple screws add torsional stability and decrease the risk of failure.

Reducing a multifragmentary proximal ulnar fracture may be difficult. Reduction can be achieved with a small distractor as shown, or an external fixator with minimal exposure and manipulation of the fracture zone. This is difficult to do with manual traction alone.

Plate application in the proximal fragment

Apply the properly contoured plate to the proximal fragment, so that it is correctly aligned with the ulnar axis (both sagittal and coronal planes). When the plate fits satisfactorily against the proximal segment, it can be attached provisionally with a single screw.

While the plate is held manually against the bone, the screw is inserted. Sometimes it is helpful to clamp the plate to the proximal fragment of the ulna with a bone forceps.

In the lateral view the plate must be parallel to the longitudinal axis of the ulna. If alignment is satisfactory, apply a second screw to secure the plate proximally in this correct position.

Alternatively, after the plate is fixed proximally with one or two screws, insert a screw distal to the plate. The fracture zone can be lengthened and disimpacted by using a laminar spreader between the distal screw and the plate. Secure reduction with a distal screw.